Reintubation of patients submitted to cardiac surgery: a retrospective analysis. / Reintubação de pacientes submetidos à cirurgia cardíaca: uma análise retrospectiva.

OBJECTIVES: To analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores. METHODS: Retrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015. RESULTS: The reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points). CONCLUSION: The reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.

OBJETIVO: Analisar pacientes em pós-operatório de cirurgia cardíaca que necessitaram de reintubação endotraqueal, e identificar os fatores associados com óbito e seu relacionamento com escores de severidade. MÉTODOS: Análise retrospectiva de informações referentes a 1.640 pacientes em pós-operatório de cirurgia cardíaca no período entre 2007 e 2015. RESULTADOS: A taxa de reintubação foi de 7,26%. Dentre os pacientes reintubados, 36 (30,3%) foram submetidos à cirurgia de revascularização miocárdica, 27 (22,7%) à substituição valvar, 25 (21,0%) à correção de um aneurisma e oito (6,7%) a um transplante cardíaco. Dentre os pacientes com comorbidades, 54 (51,9%) eram hipertensos, 22 (21,2%) diabéticos e 10 (9,6%) tinham doença pulmonar. Dentre os pacientes que tiveram complicações, 61 (52,6%) tiveram pneumonia, 50 (42,4%) desenvolveram insuficiência renal e 49 (51,0%) tiveram uma forma moderada de distúrbio transitório da troca gasosa. Foi realizada ventilação não invasiva em 53 (44,5%) pacientes. A taxa de óbitos foi de 40,3%, e a mortalidade foi mais elevada no grupo que não recebeu ventilação não invasiva antes da reintubação (53,5%). Dentre os pacientes reintubados que morreram, os valores do SOFA e do APACHE II foram, respectivamente, de 7,9 ± 3,0 e 16,9 ± 4,5. A maior parte dos pacientes reintubados (47,5%) pertencia ao grupo de risco mais elevado (EuroSCORE > 6 pontos). CONCLUSÃO: A taxa de reintubação foi elevada e se relacionou com o SOFA e o APACHE II mais graves. A mortalidade foi mais elevada no grupo que não recebeu ventilação não invasiva antes da reintubação.

Reintubação de pacientes submetidos à cirurgia cardíaca: uma análise retrospectiva / Reintubation of patients submitted to cardiac surgery: a retrospective analysis

RESUMO Objetivo: Analisar pacientes em pós-operatório de cirurgia cardíaca que necessitaram de reintubação endotraqueal, e identificar os fatores associados com óbito e seu relacionamento com escores de severidade. Métodos: Análise retrospectiva de informações referentes a 1.640 pacientes em pós-operatório de cirurgia cardíaca no período entre 2007 e 2015. Resultados: A taxa de reintubação foi de 7,26%. Dentre os pacientes reintubados, 36 (30,3%) foram submetidos à cirurgia de revascularização miocárdica, 27 (22,7%) à substituição valvar, 25 (21,0%) à correção de um aneurisma e oito (6,7%) a um transplante cardíaco. Dentre os pacientes com comorbidades, 54 (51,9%) eram hipertensos, 22 (21,2%) diabéticos e 10 (9,6%) tinham doença pulmonar. Dentre os pacientes que tiveram complicações, 61 (52,6%) tiveram pneumonia, 50 (42,4%) desenvolveram insuficiência renal e 49 (51,0%) tiveram uma forma moderada de distúrbio transitório da troca gasosa. Foi realizada ventilação não invasiva em 53 (44,5%) pacientes. A taxa de óbitos foi de 40,3%, e a mortalidade foi mais elevada no grupo que não recebeu ventilação não invasiva antes da reintubação (53,5%). Dentre os pacientes reintubados que morreram, os valores do SOFA e do APACHE II foram, respectivamente, de 7,9 ± 3,0 e 16,9 ± 4,5. A maior parte dos pacientes reintubados (47,5%) pertencia ao grupo de risco mais elevado (EuroSCORE > 6 pontos). Conclusão: A taxa de reintubação foi elevada e se relacionou com o SOFA e o APACHE II mais graves. A mortalidade foi mais elevada no grupo que não recebeu ventilação não invasiva antes da reintubação.

ABSTRACT Objectives: To analyze patients after cardiac surgery that needed endotracheal reintubation and identify factors associated with death and its relation with the severity scores. Methods: Retrospective analysis of information of 1,640 patients in the postoperative period of cardiac surgery between 2007 and 2015. Results: The reintubation rate was 7.26%. Of those who were reintubated, 36 (30.3%) underwent coronary artery bypass surgery, 27 (22.7%) underwent valve replacement, 25 (21.0%) underwent correction of an aneurysm, and 8 (6.7%) underwent a heart transplant. Among those with comorbidities, 54 (51.9%) were hypertensive, 22 (21.2%) were diabetic, and 10 (9.6%) had lung diseases. Among those who had complications, 61 (52.6%) had pneumonia, 50 (42.4%) developed renal failure, and 49 (51.0%) had a moderate form of the transient disturbance of gas exchange. Noninvasive ventilation was performed in 53 (44.5%) patients. The death rate was 40.3%, and mortality was higher in the group that did not receive noninvasive ventilation before reintubation (53.5%). Within the reintubated patients who died, the SOFA and APACHE II values were 7.9 ± 3.0 and 16.9 ± 4.5, respectively. Most of the reintubated patients (47.5%) belonged to the high-risk group, EuroSCORE (> 6 points). Conclusion: The reintubation rate was high, and it was related to worse SOFA, APACHE II and EuroSCORE scores. Mortality was higher in the group that did not receive noninvasive ventilation before reintubation.

Risk factors for transient dysfunction of gas exchange after cardiac surgery.

OBJECTIVE: A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. METHODS: We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. RESULTS: Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). CONCLUSION: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.

Risk factors for transient dysfunction of gas exchange after cardiac surgery / Fatores de risco para disfunção transitória da troca gasosa após a cirurgia cardíaca

Objective: A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods: We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results: Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). Conclusion: Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period ...

Objetivo: Estudo de coorte retrospectivo com objetivo de verificar a presença de disfunção transitória da troca gasosa no pós-operatório de cirurgia cardíaca e determinar se esse transtorno está relacionado a eventos cardiorrespiratórios. Métodos: Foram incluídos 942 pacientes consecutivos submetidos à cirurgia cardíaca e procedimentos cardíacos, encaminhados para a Unidade de Terapia Intensiva, entre junho de 2007 e novembro de 2011. Resultados: A síndrome do desconforto respiratório agudo foi observada em 15 (2%) pacientes, 199 (27,75%) pacientes apresentaram disfunção transitória da troca gasosa leve, disfunção transitória da troca gasosa moderada foi observada em 402 (56,1%) pacientes e disfunção transitória da troca gasosa grave em 39 (5,4%). A presença de hipertensão arterial sistêmica e choque cardiogênico foi associada ao surgimento de disfunção transitória da troca gasosa moderada no período pós-operatório (P=0,02 e P=0,019, respectivamente) e foram considerados fatores de risco para essa disfunção (P=0,0023 e P=0,0017, respectivamente). A presença de diabetes mellitus também foi considerada um fator de risco para disfunção transitória da troca gasosa (P=0,03). Houve correlação entre a presença de pneumonia e a presença de disfunção transitória da troca gasosa moderada em 8,9% dos casos (P=0,001). A presença de disfunção transitória da troca gasosa grave foi associada a pacientes que necessitaram de hemodiálise (P=0,0005), hemoterapia (P=0,0001), nutrição enteral (P=0,0012), ou arritmia cardíaca (P=0,0451). Conclusão: A presença de hipertensão arterial sistêmica pré-operatória e choque cardiogênico foi associada à ocorrência de disfunção transitória da troca gasosa pós-operatória. Os fatores de risco pré-operatórios foram hipertensão arterial sistêmica, choque cardiogênico e diabetes. No pós-operatório, pneumonia, pneumonia associada à ventilação, hemodiálise, hemoterapia e arritmia cardíaca foram associadas com certo grau de ...

Análise da correlação do Índice de Helkimo com a função respiratória no pré e pós-operatório de pacientes submetidos à cirurgia cardíaca: estudo piloto / Correlation analysis of Helkimo index with lung function in pre-and postoperative patients undergoing cardiac surgery: pilot study

Avaliar a articulação temporomandibular (ATM) e a função respiratória no pré e pós-operatório de pacientes submetidos à cirurgia cardíaca eletiva, com intubação orotraqueal (IOT) e verificar se há correlação entre o índice de disfunção clínica craniomandibular (IDCCM) com a função respiratória. Foram avaliados pacientes no pré, primeiro e segundo dias de pós-operatório (PO1, PO2) de cirurgia cardíaca com até 24 horas IOT. Na avaliação da ATM foi utilizado o IDCCM e para a avaliação respiratória foram utilizados a cirtometria axilar, xifoideana e umbilical, ventilometria, incluindo capacidade vital (CV), volume minuto (VM) e frequência respiratória (FR). Completaram o estudo 13 pacientes. Não foi encontrada diferença estatística entre o IDCCM nos diferentes períodos de avaliação. Houve diminuição significativa dos valores de cirtometria nas três medidas e da CV com p<0, 001. A FR apresentou aumento significativo, com p=0,01. Foi encontrada correlação negativa entre o IDCCM no PO1 e a cirtometria axilar no PO1; correlação negativa entre o IDCCM no PO2 e a cirtometria xifoideana no PO2, e correlação positiva entre o IDCCM no PO2 e FR no PO2. Pode-se concluir que o IDCCM não se alterou significativamente após intubação orotraqueal ao longo dos tempos estudados. A função respiratória apresentou diminuição dos volumes e capacidades pulmonares. A cirtometria axilar e xifoideana, assim como a FR apresentaram correlação com o IDCCM em diferentes tempos.

To evaluate the temporomandibular joint (TMJ) and respiratory function in pre-and postoperative patients undergoing elective cardiac surgery with tracheal intubation (TI) and verifying the correlation between Clinical dysfunction index (CDI) with lung function. Patients were evaluated during the first and second days after surgery (PO1, PO2) of cardiac surgery with 24 hours of intubation. For the evaluation of the TMJ was used CDI and for respiratory function were used cirtometry axillary, xiphoid and umbilical, and respirometry, including vital capacity (VC), minute volume (MV) and respiratory rate (RR). Thirteen patients completed the study. There was no statistical difference between the CDI at different stages of evaluation, and when evaluated the 5 sub-items, only the item assessing function showed significant result, p = 0.01. There was a significant decrease of the values of circumferences in the three measures and CV p <0.001. Negative correlation was found between the CDI and circumference in PO1 axillary; negative correlation between the CDI in PO2 and PO2 in xifoideana circumference, and a positive correlation between the CDI in PO2 and PO2 in the FR. It can be concluded that the CDI did not change significantly after tracheal intubation through the ages studied. Respiratory function showed a decrease in volumes and lung capacities. Cirtometry axillary and xifoideana and the FR were correlated with the CDI at different times.

Lesão pulmonar e ventilação mecânica em cirurgia cardíaca: revisão / Lung injury and mechanical ventilation in cardiac surgery: a review

A insuficiência respiratória após a cirurgia cardíaca com utilização da circulação extracorpórea pode ser resultante de inúmeros fatores relacionados às condições do sistema respiratório no pré, intra e pós-operatório. A finalidade desta revisão é discutir alguns dos fatores relacionados à lesão pulmonar observada no período pós-operatório de cirurgia cardíaca e quais os recursos ventilatórios têm sido propostos para minimizar e/ou tratar a hipoxemia dos pacientes.

Respiratory failure after cardiopulmonary bypass heart surgery can result from many pre-, intra- or postoperative respiratory system-related factors. This review was aimed to discuss some factors related to acute lung injury observed during the postoperative period of cardiac surgery and the mechanical ventilation modalities which should be considered to prevent hypoxemia.

Lung injury and mechanical ventilation in cardiac surgery: a review. / Lesão pulmonar e ventilação mecânica em cirurgia cardíaca: revisão.

Respiratory failure after cardiopulmonary bypass heart surgery can result from many pre-, intra- or postoperative respiratory system-related factors. This review was aimed to discuss some factors related to acute lung injury observed during the postoperative period of cardiac surgery and the mechanical ventilation modalities which should be considered to prevent hypoxemia.